Provider Demographics
NPI:1528401254
Name:DA SILVA, AMY SUE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:SUE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4561 MEADOWLAWN DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5413
Mailing Address - Country:US
Mailing Address - Phone:616-240-5711
Mailing Address - Fax:
Practice Address - Street 1:4561 MEADOWLAWN DR SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-5413
Practice Address - Country:US
Practice Address - Phone:616-240-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI30456401041C0700X
MI6801093753104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical